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General NPI Number Information
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NPI Number | 1700670320
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Entity Type | Individual
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Provider Name | BRANDON MICHAEL JACOBS MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 345 BROADWAY ST # 102
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City | BUFFALO
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State | NY
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Zip | 14204-1541
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Country | US
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Telephone | 929-712-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 PORTAGE RD
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City | NIAGARA FALLS
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State | NY
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Zip | 14301-1154
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Country | US
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Telephone | 929-712-7183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 171000000
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License Number State | AS
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